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Materials HED454

The document is a form for the State Aid Reimbursable Programs related to materials used in various projects such as Chapter 90, Muni Bridge, and Complete Streets. It includes sections for vendor information, item details, quantities, unit prices, and total amounts, along with a declaration of compliance with Chapter 779 of the Acts of 1962. The form requires signatures from a supervisor and town accounting for approval.

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6 views2 pages

Materials HED454

The document is a form for the State Aid Reimbursable Programs related to materials used in various projects such as Chapter 90, Muni Bridge, and Complete Streets. It includes sections for vendor information, item details, quantities, unit prices, and total amounts, along with a declaration of compliance with Chapter 779 of the Acts of 1962. The form requires signatures from a supervisor and town accounting for approval.

Uploaded by

chris.cn.na
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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STATE AID REIMBURSABLE PROGRAMS - MATERIALS - HED 454 FORM

Updated 12/2017

City/Town of: _________________________________

PROJECT NAME: __________________________________________________

PROGRAM TYPE: Chapter 90 ⃝ Muni Bridge ⃝ Complete Streets ⃝ Other ⃝

MATERIALS for period beginning and ending


both inclusive, on account of Contract No. with MassDOT Highway Division,

VENDOR ITEM # QTY. UNIT UNIT AMOUNTS CHECK REMARKS


NAME PRICE #
$ $
$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

$ -

TOTAL $ -
"To the best of my knowledge the purchases of materials or services appearing
on this sheet are not in conflict with Chapter 779 of the Acts of 1962.
Signed under the penalty of perjury."
Supervisor / Foreman Date Town Accounting Approval Date

HED-454 (R)

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